Safety of Same-Day Discharge after Bariatric Operation: A Retrospective 6-Year North American Analysis.

BACKGROUND:With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID, there has been interest in same day discharge (SDD) for bariatric operation. The aim of this study was to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric operation. STUDY DESIGN:We analyzed the MBSAQIP database from 2016-2021 to characterize trends in SDD for minimally invasive bariatric operation. Multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. A comparative analysis of postoperative outcomes within 30 days was performed for SDD and admission after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities. RESULTS:SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black/African American race, history of myocardial infarction, renal insufficiency, DVT and smoking. SDD for RYGB had 72% increased risk of postoperative complications compared with SG. The overall major complications were lower in SDD cohort vs admission cohort (OR 0.62, p<0.01). However, there was a significant increase in deaths within 30 days (OR 2.11, p=0.01), cardiac arrest (OR 2.73; p<0.01), and dehydration requiring treatment (OR 1.33; p<0.01) in SDD cohort compared with admission cohort. CONCLUSIONS:Nationally, there has been rise in SDD for bariatric operation from 2016-2021. Matched analysis demonstrates that SDD is associated with a significantly higher mortality rate. Additionally, the risk of complications with SDD is higher for RYGB compared with SG. Therefore, further studies are required to appropriately select patients for whom bariatric operation can be safely performed as an outpatient.